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How Industrial Action Affects Quality Healthcare Delivery in Nigeria

The Nigerian health system has been plagued with numerous healthcare worker strikes. These results in the closure of public healthcare institutions, preventing Nigerians’ access to quality health services.

The right to strike is widely considered a civil right and is often part of a country’s legal system. The dissonance has drawn renewed attention to the longstanding crisis of care in Nigeria’s creaking public hospitals.

The strikes arise mostly from disputes between medical doctors and other health workers over a range of issues, including salary levels and emoluments, leadership of teaching hospitals, and appointment of the Minister of Health. Other health workers, who allege that doctors are favoured in the system, have formed Joint Health Sector Unions to confront the doctors, which is an umbrella trade union that incorporates pharmacists, nurses, midwives, physiotherapists and other non-medics.

Meanwhile, for some professional groups, including health workers, strikes might have implications beyond the involved parties. Health workers’ strikes has been purported as putting patients at risk of serious harm and potentially contradict health workers’ duties to care for their patients.

The provision of health services depends on several factors, but the availability and retention of human resources is particularly important. The health care worker (HCW) to population density in Nigeria (20 doctors, nurses and midwives per 10,000 population) is a little below the WHO recommendations of 23 per 10,000.

Moreover, the health workers in Nigeria are poorly distributed in favour of urban areas, southern zones, secondary and tertiary health care facilities. This inequitable distribution of skilled birth attendants is very apparent in the northern parts of the country and primary health care facilities in rural areas.

The shortage of skilled birth attendants such as midwives and doctors in rural Nigeria affects the utilization of services by women in these areas. Every single day, Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age, according to UNICEF. This makes the country the second largest contributor to the under five and maternal mortality rate in the world.

Dilapidated health care systems have facilitated medical tourism, for instance, leading to over 5000 people leaving Nigeria every month for various forms of treatment abroad and about 1.2 billion US dollars lost from the Nigerian economy to medical tourism yearly.

Thought leaders had repeatedly noted that while elites can afford the services of private institutions and can seek health care services outside Nigeria even at the expense of the government, healthcare workers would also be fully paid irrespective of the strike action. The only serious consequence is the pain of the masses, coupled with a surge in the number of preventable deaths.

These strikes resulted in disruption to service delivery and training programmes, increased morbidity and mortality of patients and loss of confidence in the hospitals and the health care professions.

Some have argued that such strikes would be justified if directed towards improving workers’ conditions and their ability to care for future patients and that doctors’ strikes may be morally acceptable if proportionate and properly communicated.

Although many of Nigeria’s lowest-paid workers are receiving the 67 percent increase afforded to low-wage public-sector workers under the new law, an increase in public-sector workers at all but the lowest skill levels remains in contention.

Questions have been raised about just how far a strike can go at fixing the problems that ail the health system of Africa’s largest economy and who, exactly, stands to gain and lose when health workers walk off the job.

Most problems and their solutions lie within human resources, budget allocation and management. These should be accorded the highest priority for better health outcomes. Identified causes of these continued strikes, especially inadequate healthcare leadership/management, must be tackled in order to eliminate industrial action by healthcare workers.

Training doctors in health management and leadership towards building skilled physician leaders is a strategy that is long overdue in Nigeria. Health workers need to be reminded of their respective professional and ethical oaths which places the patients’ need before their own. This is important for the global move towards a more patient-centred approach to the delivery of health services. The Federal Government also must respect agreements made with the management of healthcare institutions.

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